www.HIMSSConference.org
#PrecisionHIT
FEBRUARY 11, 2019
ORLANDO, FL
Precision Medicine’s
“Last Mile” Problem
2
https://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-global-perspective
3
https://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-global-perspective
A Trillion
Dollars!
Johns Hopkins inhealth
PRECISION MEDICINE
Nexus of measures, models and forecasts
Charting to Health
+ Improve pace of discovery
+ Remove barriers
Translation
of discoveries
into Delivery
+ Multidisciplinary approach
+ IRB approved and secure
+ Deliberately practicing what we learn
+ Expand the reach of care
Discovery
for research
OUR APPROACH
Centers of Excellence
Vision for
Clinical Impact
Seeking clinical impact, not open
ended research, by providing
templates for:
• Framing scientific aims coupled with
measurement
• Afferent data collection
• Research cohort development
• Data management
• Novel approaches to subgrouping
• Data science driven clustering
• Organization capability growth –
data science
• Sustainable funding
CoEs commit to value framework
and plan:
• Point of care application
• Impact / Cost Measurements
• Efficiency of Care / Reimbursements
• Value to Health System / Payors
• Value to Industry
• Reputation
• Grants / Philanthropy
• Lower Research Barriers / Cost
• Path to sustainability / commercialization
Drives all other phases
Science
Old Model
• Study within own disease space
• Questions and Measures
constrained – exclusively focused
on open ended discovery
• “First Copies” – Everyone built
their own research system from
scratch
• Not limited by what you already have
and what you already know
• “Does it matter?” – For example,
if you define a new patient subgroup,
can you measure whether that
identification is useful in practice?
• Modular – apply data, expertise,
and patterns from multiple areas
• “Docker Containers” concept
New Model
Traditional Roles
• Multidisciplinary team with
clinical and research
responsibilities
• Faculty
• Data managers
• Research staff
• Clinical staff
• Shared across the research
enterprise to allow better application
of tools and patterns across fields
• Data Scientist – Advanced analytics,
Data-driven hypothesis generation
• Operational Lead – Value within
JH Health System
• Health Economist – Value outside JH
Key New Roles
HDInsight
ADLS
Azure Cloud
EMR
Imaging
PhysMon
Registry
Genomics
CrunchR Analytics
Virtual Desktop
Schema on
Read
Containerized analytics,
portable to compute
RDS
SQL Server
Postgres
Object
and file store
Identity,
features
normalized
& coalesced
Commons
Tech Stack
Delivery
Practice what
we’ve learned
Extending reach
to all patients
who can benefit
Workflow
Integrated
Minimum-
Viable-Data
Patient Centered Outcome
Informed
PRECISION HAS A
LAST MILE PROBLEM
How do you reach patients?
Can you reach providers?
At scale?
Interoperable?
Proprietary?
Clinically Valid?
AI Lifecycle?
Adoptable?
Integrated?
Privacy & consent?
Liability?
Reimbursable?
Creating framework to
evaluate, prioritize and select
high impact conditions for
intervention.
Maryland is primed
for intervention
HSCRC Care
Redesign
Reimbursement
Total cost
of care
CRISP
Impact to Johns Hopkins:
$$$ hundreds of millions
Maryland impact
$5B+
COPD Cases
190,000
Scale Matters: COPD
Empower
the patient
Meeting providers
where they are
Care
Redesign
Minimum-
Viable-Data
CLOSING
THE GAP
Shift to open-
ecosystems
www.HIMSSConference.org
#PrecisionHIT
Dwight Raum
Johns Hopkins Medicine
@HopkinsMedicine
@HopkinsInHealth
